Decreasing methotrexate dose after remission or low disease activity in case of rheumatoid arthritis patients: a clinical course observation

Abstract

Objective: In patients with rheumatoid arthritis (RA) that maintained remission (REM) or low disease activity (LDA) at least for one year by methotrexate (MTX), the clinical course after decreasing MTX was evaluated respectively.
Methods: Twenty-six RA patients (3 males and 23 females) whose average age was 60 years and average disease duration was 9 years with REM or LDA maintained for at least one year were enrolled. Twelve RA patients (1 male and 11 females) whose average age was 60 years and average disease duration was 9 years who decreased or stopped MTX due to adverse events (AE) were evaluated for control. Rheumatoid activity (DAS28CRP) was observed for one year after MTX decreased in the REM or LDA group and the AE group.
Results: After MTX was decreased in the REM or LDA group, 11 cases (42%) were relapsed. On the other hand, in AE group (N=11cases), 7 cases (58%) were relapsed. The decreased MTX dose was significantly (p<0.05) lower in AE group compared with REM or LDA group. In REM or LDA group, the decrease in MTX was maintained in 9 cases out of 11 cases that relapsed after decreasing MTX. In 3 cases out of 7 cases with MTX decreased due to liver disorder, the same MTX dose was administered again because rheumatoid activity relapsed after increasing the folic acid dose.
Conclusion: In 26 RA patients who maintained REM or LDA at least for one year by MTX therapy, 15 cases (58%) continue REM or LDA after decreasing MTX. This study shows the possibility that decreasing the MTX dose is useful for RA patients after REM or LDA.